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“Despite the cost pressures, liability constraints, resistance to change and other seemingly insurmountable barriers, it is simply not acceptable for patients to be harmed by the same healthcare system that is supposed to offer healing and comfort. “First do no harm” is an often quoted term from Hippocrates. Everyone working in healthcare is familiar with it. At a very minimum, the healthcare system needs to offer that assurance and security to the public.”

“Aviation safety was not built on evidence that certain practices reduced the frequency of crashes. Instead, it relied on the widespread implementation of hundreds of small changes in procedures, equipment, training and organization that aggregated to establish an incredibly strong safety culture and amazingly effective practices. These changes made sense; were usually based on sound principles, technical theory or experience; and addressed real- life problems, but few were subjected to controlled experiments.”

“Policymakers must consider the entire experience with safety practices, both in healthcare and other industries, when deciding which practices should be recommended for widespread use. Evidence from randomized trials is important information, but is neither sufficient nor necessary for acceptance of practice. For policymakers to wait for incontrovertible proof of effectiveness before recommending a practice would be a prescription for inaction and an abdication of responsibility…the prudent alternative is to make reasonable judgments based on the best available evidence combined with successful experiences in health care. While some errors in these judgments are inevitable…they will be far outweighed by the improvement in patient safety that will result.”